Specialty Pharmacy Financial Access Coordinator, Lead; ; Full Time; Days

Description

Under direct supervision of the Director of Specialty Pharmacy, the Specialty Pharmacy Manager and the Specialty Pharmacy Clinical Liaison, the Specialty Pharmacy Access Coordinator Lead supervises Financial Access Coordinator staff and interacts with clinical employees on multiple levels, including pharmacists, nurses, medical/clinical staff, Finance personnel, department managers, access services staff, and Billing Assistants. External contacts may include third party payers, accrediting bodies, insurance /PBM companies, government peer review organizations, accrediting bodies,external partners, and referring physicians. The relationships are inherent to the success of this position. The Lead is primarily responsible for, but not limited to, oversight of staff responsible for the prompt attention to prior authorization of specialty medications, oversight of the quality of work done in key department systems, support of medical staff, assistance in obtaining financial support for patients, and timely communication with medical providers, including mail correspondence, messaging, telephone correspondence and EHR documentation.

Responsibilities

1.Organizes the duties of subordinate technical and clerical personnel, including less experienced Specialty Financial Pharmacy Access Coordinators, and billers.

2.Maintains thorough documentation on all authorization requests, prescription verifications and other data by facility.

3.Supports supervising Pharmacists.

4.Supports manages and directors in the training and mentoring of new pharmacy personnel; nurtures a teamwork environment.

5.Periodically meets with and manages vendors and pharmaceutical manufacturers.

6.Supports, facilitates, and reviews departmental projects, initiatives, and partner programs

7.Works with department pharmacists and administrators to design, administer, and support quality assurance and related tasks

8.Accesses and reviews work in all key department systems (dispense, clinical management, EMR)

9.Organizes and presents reports and analytics as requested.

10.Reviews and evaluates outpatient take-home prescriptions and determines feasibility of processing through patient and payer-preferred specialty pharmacy and, if not, coordinates service with the correct pharmacy group.

11.Obtains prior authorizations from intermediaries and payers, including managed care companies, insurance companies or others as appropriate. Ensures completion of activities that maximize revenue capture for high-cost medications.

12.Facilitates a high level of customer service by the completion of applications, including those for the Patient Assistance Program (PAP) and co-pay assistance.

13.Interacts with medical and professional staff on a case by case basis to obtain appropriate clinical documentation to ensure accurate indications in the patient's medical record before completion of third party authorization. This may include contacting referring physicians for information.

14.Communicates with appropriate individuals (i.e., patient, providers, and pharmacy staff) regarding outcomes of prior authorizations and responds to complex questions from third party payers and clinical staff regarding medication-related issues and reimbursement.

15.Adjudicates approved prescriptions through the pharmacy software system or begins the appeal process for denied prescriptions.

16.Processes PAP (Patient Assistance Program) requests. Documents actions taken, runs weekly reports, keeps open lines of communication by facilitating between pharmacy, other healthcare professions, the patient, medication manufacturers and third party payers.

17.Runs Pharmacy benefit checks at the providers' requests; periodically performs software tests for proper functionality to ensure coverage for specific medications.

18.Maintains compliance with all pertinent regulations and laws (HIPAA, Board of Pharmacy, etc).

19.Other duties as assigned.

Education RequirementsAssociates degree (Bachelor's degree preferred)

Qualifications

3+ years of retail pharmacy technician experience or related health care administrative, and a strong familiarity with the prior authorization process preferred. Working knowledge of third party payer plans and how they are processed, of medication reimbursement, including the prior authorization process, proficiency in the procurement of financial assistance for patients with government-sponsored health plans including Medicare , Medicaid and TriCare.

Preferred:

3 years of health care related billing and benefits investigation

1 year of retail pharmacy experience

1 year of PBM payer operations

1 year of hospital/institutional pharmacy

Compensation Statement

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $59, $78,000.00 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

Non-Bargaining Unit, 203 - HSO PHARMACY BENEFITS MANAGEMENT - MSH, Mount Sinai Hospital

Employer Description

Strength through Unity and Inclusion

The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai's unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.

At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.

About the Mount Sinai Health System:

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's "Best Children's Hospitals" ranks Mount Sinai Kravis Children's Hospital among the country's best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's "The World's Best Smart Hospitals" ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

Equal Opportunity Employer

The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

Compensation

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $ $78000 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.